Swiss Re Reinsurance Solutions - Claims Automated Rules Engine – Insurer Innovation Award 2023

1. 1
Claims
Automated
Rules Engine
Evolving customer experience with speedy claims assessmentand decisions
ReinsuranceSolutions

2. WHAT IT IS:
A powerful engine to streamline the claims process by triaging
submissions, automating tasks and decisions, and providing next action
recommendations – ultimately enabling claims experts to spend more
time where they make the most difference
WHAT MAKES IT GREAT:
 Assists claims experts in making claims decisions by assessing the
nature of the claim and quality of claims evidence against a set of
customizable risk-based rules.
 Provides access to Swiss Re’s extensive, global claims knowledge in
an automated and scalable way
 A cloud-based software-as-a-service solution for quick
implementation, and users benefit from continued enhancements
IMPACT TO AN INSURER’S BUSINESS:
Claims
Automated Rules
Engine
2
Improved
consistency, accuracy
and confidence in
claims outcomes
Efficiency gains –
adjudicators have
more time to focus
on areas where
they make the most
difference
Faster claims
response times –
deliver decisions in
minutes, not
months
Claims experts work in an emotionally
demanding area, often with significant
administrative burdens and tight turnaround
demands. CARE frees up claims experts to
focus on claims that need the most attention.

3. 3
Health or
Life
Claim
Claimant
A significant,emotional event. At
their most vulnerable
Claims Team
Stressful, upsetting, emotionally
draining – nature & volume of
claims
The process can be challenging
for all involved
Automation can improve the experience for everyone &
brings additional benefits

4. Why would an
insurer choose
Swiss Re’s Claims
Automated Rules
Engine solution?
Our experience & reach
Rules designed
by our claims experts
alongside our clients
Developed for insurer all over the
world
Can be used standalone or
as part of our full digital
value chain
01
One of world’s largest
reinsurer — unrivalled
insight & expertise
03
The global benchmark
for applied risk
knowledge
02
A reputation for innovation
& automation excellence
04
For use by any business,
anywhere — flexible,
digital solutions using
cloud technology, API
Our solutions reflect Swiss Re’s 150+ years’
experience & world-leading reputation

5. The standards of customer service that people now
expect,
are set by forward-thinking companies outside the
insurance
world. We must evolve.
5
Automation of easy tasks frees up claims
handlers to spend more time with customers
when they need support most
A personal, empathetic touch
Claims decisions in weeks not months. Ensure claims are assessed &
managed by the right claims experts at the right time
A seamless, streamlined process
Trust generates loyalty &
brand advocacy
Transparency & confidence
We help insurers offer their
customers:
“
Our
Claims Automated
Rules Engine helps
improve the
claims experience

6. 6
Our
Claims Automated
Rules Engine
helps insurers to
boost
their business
Automation through our solution means:
01
Efficiency
Spend less time on easy
tasks & focus resource
where it’s most needed
Erase those pain
points
& inefficiencies!
The time it takes to create
timelines & claim summaries
The effort in ensuring that the
right benefit entitlements are
being applied
Endless scrolling through
documents to find
specific information
Having to have multiple
screens & documents open
Spending time on admin
rather than assessment &
case management
02
Profitability
Through efficiency, customer
loyalty & advocacy
03
Confidence in your
decisions
Through robust automated rules &
renowned Swiss Re insight &
support
04
Future proofing
Digital transformation & credibility

7. 7
How does Claims
Automated Rules Engine
work?
01
Swiss Re claims
experts design rules
alongside our clients to
classify & identify
claims by their risk
level & complexity
02
Rules integrate with
client’s processes &
systems & pre-
populate a
questionnaire
03
Questionnaire prompts
claims expert to
complete more
sophisticated risk
profile questions to
generate a risk score
— ensures questions
are relevant &
necessary to the
circumstance & claim
type
04
Decision outcome or
recommend actions
provided, depending
on client preferences
05
Swiss Re offers
decision support for
more complex cases,
where needed

8. 8
How does Claims
Automated Rules Engine
work?

9. 9
How does Claims
Automated Rules Engine
work?
Co-creation of claims risk
profiling rules
Co-create tools to complement our Clients’ operating models,
risk management practices and risk appetites ensuring the
right claims are being assessed and managed by the right
claims expert at the right time
Rules are designed by Swiss Re
Claims Experts along side our Clients to identify and classify
claims by their risk level
and complexity
Connect Client claims management systems to a web based
dynamic and reflexive questionnaire and rules engine where
available claim data is pre-populated. The questionnaire will
prompt the claims expert to complete the more sophisticated risk
profile questions to generate a risk score, decision outcome or
recommendation depending on Client preference
Expert driven proposition Integration with your process and
system

10. 10
Claims
Automated
Rules Engine
in action
Swiss Re partnered with
its largest client in China to:
Speed up claims
assessments & decisions
Maintain consistency
& accuracy
Ensure claims were allocated
to claims experts with the
right experience
Process:
Co-created critical illness
rules for risk scoring
Developed sophisticated rules
for 10 critical illness conditions
accounting for
of client’s critical illness portfolio
90%

11. 11
Benefits
of our Claims
Automated
Rules Engine
Get up and running in
just a few months —
light touch integration
Simple to use while
maintaining quality of
decision making
Ready access to rules-
based
updates, developed in
partnership with you
24/7 self service support
infrastructure backed by
Swiss Re globally
Cheaper than traditional
claims solutions —
‘software as a service’
Use standalone, or
integrated with our other
suite of claims solutions

12. In Summary
What Swiss Re’s
Claims Automated
Rules Engine
offers insurers
• Automation to improve the life
and health claims experience
for customers and claims
handlers
• The best of Swiss Re —
combines our reputation for
innovation and automation
excellence with our unrivalled
risk insight and expertise
• Digital credibility — future
proofing, API, cloud technology
• Increased profitability —
through efficiency, customer
loyalty and advocacy
• A custom-fit, scalable and
affordable solution
• A solution that can standalone
or as part of a Swiss Re digital
value chain ecosystem
• Easy implementation whether
the insurer has an existing
system or are new to
automation
• Swiss Re support every step
of the way — design,
implementation, day-to-day
trouble-shooting and
claims support
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